Risk for Autism Increases for Abandoned Children Placed in Institutions

Study published in JAACAP shows that abandoned children placed in child-centered foster care environments improves social behaviors

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Washington D.C., February 2, 2015

A recent study published in the February 2015 issue of the Journal of the American Academy of Child and Adolescent Psychiatry demonstrates that children who were abandoned to institutional care have an increased risk for behaviors similar to those seen in children with autism, including impaired social communication. When these children were moved into child-centered foster family care at a young age, their social behaviors improved.

As part of the Bucharest Early Intervention Project (http://www.bucharestearlyinterventionproject.org), 136 children abandoned at birth and raised in institutions in Bucharest, Romania were randomly assigned to either continued care as usual in the institution, or high quality foster care created and maintained by the investigators. The children averaged 23 months of age at the time of randomization.

At 10 years of age, 117 children were assessed. Each child's primary caregiver filled out the Social Communication Questionnaire (SCQ), which assesses for symptoms associated with autism, including social communication skills. Children with concern for possible autism were then referred for a full neurodevelopmental evaluation to determine whether they met the Diagnostic and Statistical Manual of Mental Disorders (DSM) criteria for autism.

Five children with a history of institutional care (three in the institutional care as usual group and two in the foster care group) met the DSM diagnostic criteria for autism spectrum disorder. In a comparison group of 100 age-matched, never-institutionalized children living in Bucharest, Romania, no child met criteria for autism spectrum disorder. Based on SCQ scores, children in the foster care group were identified as having more typical social behaviors compared to children in the institutional care as usual group.

These findings suggest that children with a history of institutional care are at increased risk for behaviors associated with autism, including social communication difficulties. These behaviors improved with an early intervention of quality foster care.

The authors strongly emphasize that in the vast majority of autism cases in the general population, children are raised in caring families, and psychosocial deprivation plays no role. "Although the institutionalized children with autism resemble children with autism in the general population, the origins of their symptoms are very different," says Charles A. Nelson PhD of Boston Children's Hospital and Harvard Medical School, who is senior author on the paper. "We believe that both groups suffer deprivation, but of different types: In institutionalized children, the deprivation comes from their environment, while in the general population, the autism itself causes a kind of deprivation, making it harder for children to perceive and understand social cues."

The article "Social Communication Difficulties and Autism in Previously Institutionalized Children" by April R. Levin, Nathan A. Fox, Charles H. Zeanah, Jr., and Charles A. Nelson, (http://dx.doi.org/10.1016/j.jaac.2014.11.011) appears in the Journal of the American Academy of Child and Adolescent Psychiatry, Volume 54, Issue 2 (February 2015), published by Elsevier.

The Sinneave Foundation, the John D. and Catherine T. MacArthur Foundation, the Binder Family Foundation, and the National Institute of Mental Health (MH091363) provided funding for this project.

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Notes for editorsFull text of the article is available to credentialed journalists upon request; contact Mary Billingsley at +1 202 587 9672 or mbillingsley@jaacap.org. Journalists wishing to interview the authors may contact Bethany Tripp in Public Affairs at Boston Children's Hospital at bethany.tripp@childrens.harvard.edu or at +1 617 919 3110.

All articles published in JAACAP are embargoed until the day they are published as in press corrected proofs online at http://jaacap.org/inpress. Articles cannot be publicized as in press accepted manuscripts. Contents of the publication should not be released to or by the media or government agencies prior to the embargo date.

About JAACAPJournal of the American Academy of Child and Adolescent Psychiatry (JAACAP) is the official publication of the American Academy of Child and Adolescent Psychiatry. JAACAP is the leading journal focusing exclusively on today's psychiatric research and treatment of the child and adolescent. Published twelve times per year, each issue is committed to its mission of advancing the science of pediatric mental health and promoting the care of youth and their families. www.jaacap.com

The journal's purpose is to advance research, clinical practice, and theory in child and adolescent psychiatry. It is interested in manuscripts from diverse viewpoints, including genetic, epidemiological, neurobiological, cognitive, behavioral, psychodynamic, social, cultural, and economic. Studies of diagnostic reliability and validity, psychotherapeutic and psychopharmacological treatment efficacy, and mental health services effectiveness are encouraged. The journal also seeks to promote the well-being of children and families by publishing scholarly papers on such subjects as health policy, legislation, advocacy, culture and society, and service provision as they pertain to the mental health of children and families.

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